Sexually tranismitted diseases
INTRODUCTION :
* Sexually transmitted diseases (STDs) are common and preventable causes of morbidity and serious complications.
*Untreated chlamydial and gonococcal infection may result in pelvic inflammatory disease, which can lead to infertility, ectopic pregnancy, and chronic pelvic pain in 10 to 20 percent of cases .
*STDs can also result in adverse outcomes in pregnancy, including spontaneous abortion, still birth, premature birth, and congenital infection .
*Finally, the presence of STDs can facilitate HIV transmission . Thus, primary prevention of STDs needs to be given high priority
Risk factors:
*Unmarried status Residence in an urban area
*New sex partner(s)
*Multiple sexual partners
*(concurrent) History of a prior STD
*Illicit drug use Contact with sex workers ,All patients who have a history of, or risk factors for, an STD should be offered HIV testing.
RISK GROUPS:
* homosexual men with multiple partners
*and adolescents (each year approximately one half of the estimated 19 million incident STD infections in the United States occur in young people ages 15 to 24),
*frequent travelers , Armed services personnel , Entertainers
Symptoms :
consistent with common STDs, including genital ulceration , rash , itch , pain or swelling& urinary symptoms especially burning on micturition , urethral or vaginal discharge.
Types and their pathogenic causes
Bacterial
Chancroid (Haemophilus ducreyi)
Donovanosis (Granuloma inguinale
Gonorrhea (Neisseria gonorrhoeae)
Lymphogranuloma venereum (LGV)
Non-gonococcal urethritis (NGU)
Staphylococcal infection (Staphylococcus aureus, MRSA)
Syphilis (Treponema pallidum)
Chlamydial (chlamydia trachomatis )
Fungal
Tinea cruris , Yeast Infection .
Viral
Adenoviruses
Viral hepatitis (Hepatitis B virus) - saliva, venereal fluids. (Note: Hepatitis A and Hepatitis E are transmitted via the fecal-oral route; Hepatitis C is rarely sexually transmittable, and the route of transmission of Hepatitis D (only if infected with B) is uncertain, but may include sexual transmission
Herpes Simplex (Herpes simplex virus (1, 2)) skin and mucosal, transmissible with or without visible blisters
HIV/ AIDS (Human Immunodeficiency Virus) - venereal fluids
Genital warts , Human papillomavirus HPV) - skin and muscosal, transmissible with or without visible warts
Molluscum contagiosum
(molluscum contagiosum virus MCV
mononucleosis
(Cytomegalovirus CMV - Herpes 5)
(Epstein-Barr virus EBV - Herpes 4)
Parasites, Pubic lice, Scabies
Protozoal
Trichomoniasis (Trichomonas vaginalis
Global chlamydia statistics show that an estimated 92 million new chlamydia infections occur each year, affecting more women (50 million) than men (42 million).
Chlamydia is caused by the bacterium chlamydia trachomatis. This bacteria can infect the cervix in women and the urethra and rectum in both men and women. Occasionally chlamydia can also affect other parts of the body, including the throat and eyes.
Chlamydia often has no symptoms, especially among women. If left untreated, chlamydia can cause serious problems later in life.
Those who do have symptoms of chlamydia may experience:Women
An increase in vaginal discharge caused by an inflamed cervix; the need to urinate more frequently, or pain whilst passing urine; pain during sexual intercourse or bleeding after sex; lower abdominal pains; irregular menstrual bleeding.
Men
A white/cloudy and watery discharge from the penis that may stain underwear;
a burning sensation and/or pain when passing urine;
pain and swelling in the testicles.
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrheoae.
Gonorrhea affects both men and women and can infect the cervix, urethra, rectum, anus and throat.
Gonorrhea is one of the most common sexually transmitted diseases (STDs) and the global gonorrhea statistics show that an estimated 62 million cases of gonorrhea occur each year, affecting more women than men. Gonorrhea is easily curable but if left untreated it can cause serious health problems such as pelvic inflammatory disease (PID), which can lead to abdominal pain and ectopic pregnancy in women.
Untreated, gonorrhea can also lead to infertility, meningitis and septicaemia.
Gonorrhea symptoms
can include:
Women
A change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.
A burning sensation or pain whilst passing urine.
Irritation and/or discharge from the anus.
Men
A white or yellow discharge from the penis.
A burning sensation or pain whilst passing urine.
Irritation and/or discharge from the anus.
*Commonly reported prevalences of STIs among sexually active adolescent girls both with and without lower genital tract symptoms include chlamydia trachomatis (10 to 25%), Neisseria gonorrhoeae (3 to 18%), syphilis (0 to 3%), Trichomonas vaginalis (8 to 16%), and herpes simplex virus (2 to 12%).Among adolescent boys with no symptoms of urethritis, isolation rates include C. trachomatis (9 to 11%) and N. gonorrhoeae (2 to 3%).
Methods of control :
Preventive measurs :
In general, the following preventive measures applicable to all STDS:
* early detection & effective treatment of infective patients & their contant.
* educate the community in general health promotion measures, provide health & sex instruction that teachs the value of delying sexual activity until onset of sexual maturity as well as the importance of establishing mutually monogamous relation ship & reducing numbers of sexual parteners, encourage stable family and providing marriage facilities .
* protect the community by preventing & controlling STDS by teach methods of personal prophalaxis applicable before, during & exposure, espaceially the correct & consistent use of condom.
* provide health care facilities for early diagnosis & treatment of STDS , incorrege their use education of the poplic about symptoms of STDS & mode of spread. Establish intensive case finding programs.
*Vaccines are available that protect against some viral STIs, such as Hepatitis B and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.
Hepatitis B — The primary risk factors that have been associated with hepatitis B infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, and history of other STDs. MSM and injection drug users are considered high risk groups for HBV acquisition
All pregnant women receiving STD services should be tested for HBsAg, regardless of whether they have been previously tested or vaccinated
All HIV-infected patients should receive HBV immunization.
Human papillomavirus — Immunization with human papillomavirus (HPV) vaccine is recommended by the CDC in girls and women 9 to 26 years of age is administered in three doses at 0, 2, and 6 months , There is no data on vaccine efficacy in men.
Human immunodeficiency virus — No vaccine is currently available for HIV prevention .
Syphilis
Identification : an Acute & chronic treponemal disease characterized clinically by a primary lesions , a secondary eruption involving skin & mucous membranes , long periods of latency , and late lesions of skin, bone , viscera , the CNS and CVS. The primary lesion ( chancre ) usually appeare about 3 weeks after exposure as indurated, painless ulcer with serous exudates at site of initial infection .
Fetal infection occurs with high frequency in untreated early infections of pregnant women . it frequency cause abortion or stillbirth , infant death , deliver of LBW infants .
The laboratory diagnosis of syphllis is usually made serological test of blood & CSF .
It usually more prevalent in urban than rural areas , in males more than in females , low socioeconomic classes , risk factors include illicit drug use , prostitution , AIDS, early age of first sexual intercourse.
Infectious agent : Treponema pallidum .
Reservoir : humans
Incubation period : from 10 days to 3 months .
Mode of transmission :
1- direct contact with infectious exudates of infected people during sexual contact .
2- transplacental infection of the fetus occure during the pregnancy of infected women
3- transmission can occur through blood transfusion if the donor is in the early stages of the disease .
4- infection by contact with contaminated articles is rare .
Period of communicability : communicability exists when moist lesions of primary & secondary syphilis are present .
Methods of control :
Preventive measures : same with STDs , syphilis serology should be included in all cases of STD & as a routine part of prenatal examination .
Control of patient, contacts & the immediate environment :
1- Case report of early infectious syphilis & congenital syphilis is required .
2- Isolation : for hospitalized patients , universal precautions for blood & body secretions should be applied & should refrain from sexual intercourse until until treatment is completed and lesion disappear .
3- Concurrent disinfection : none in adequantely treated cases , care to avoid contact with discharges from open lesions .
4- Immunuzation of contacts : none
5- Quarantine : none
6- Investigation of contacts & source of infection : interviewing of patients to identify sexual contacts whom infection was acquired & to those whom the patient may have infected .
7- Specific treatment : long acting penicillin G , 2.4 million units given in a single IM , alternative therapy for nonpregnant pencillin allergic are either doxicycline 100 mg twice daily for 14 days or tetracycline 500 mg , 4 time per day fpr 14 days .
Erythromycin can be used for pencillin sensitive pregnant women . For early congenital syphilis , aqueous crystalline pencillin G can given .